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NPI Code Detail

MEDICARE: JESSICA BOSWORTH RD, LDN

MEDICARE: JESSICA BOSWORTH RD, LDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDN008468PA

General Provider Information

NPI Number : 1932959129
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BOSWORTH RD, LDN
Provider Business Mailing Address
First Line : 1515 LATONA ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19146-3126
Country : US
Telephone Number : 267-566-9249
Fax Number :
Provider Business Practice Location Address
First Line : 2 LOGAN SQ STE 300
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-2733
Country : US
Telephone Number : 267-566-9249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2024
Last Update Date : 02/04/2026

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Directions to “ JESSICA BOSWORTH RD, LDN” Practice Location

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